Iron Status in Patients With Congestive Heart Failure at Kenyatta National Hospital

Abstract

Congestive heart failure is associated with increased morbidity and mortality. It is common among the elderly and tends to co-exist with other co-morbid conditions; anaemia, diabetes and hypertension among others. It is also associated with nutritional deficiencies of micro-nutrients; minerals including iron and vitamins. The role of iron in anaemia and congestive heart failure has been studied extensively, with some reports demonstrating a negative relationship between low serum iron levels and congestive heart failure; functional classification, morbidity in terms of duration of hospital stay and anatomical changes associated with iron deficiency. Most published reports on the subject matter indicate increased morbidity associated with iron deficient state. However, there are no local studies to compare with. This study assessed serum iron levels and correlated it with the functional classification of heart failure using New York Heart Association (NYHA) classification of the patients. Objective: To assess the iron status and prevalence of anaemia among patients with congestive heart failure at the Kenyatta National Hospital. Methods: the study was a cross sectional descriptive study carried out at the out-patient cardiac clinic at the Kenyatta National Hospital over a 6 month period. Adults and minors over 13 years of age who had a confirmed diagnosis of heart failure were interviewed, patient records were perused and the information extracted, was recorded in the study proforma. Every participant was examined and blood samples taken for determination of serum iron and haemoglobin levels. Data analysis was then done using statistical package for social scientists (SPSS) version 24. Descriptive analysis was done to summarize serum ferritin, transferring saturation (TSAT), haemoglobin (HB), body mass index (BMI), sex, iron status, aetiology of congestive heart failure (CHF) and NYHA. Chi square test was used to determine associations between iron status, anaemia and NYHA. A two tailed chi square test was done at 95% confidence level. Results: The study was conducted between January and July 2015 at the Kenyatta National Hospital out-patient cardiac clinic. A total of 1136 patients were on follow up at the clinic were screened to identify those with a diagnostic label of congestive heart failure. 360 patients with an age range of between 14-98 years and a mean age of 53.4 (SDwere recruited into the study after meeting the inclusion criteria. There was a female preponderance of 53.1% and a high literacy level with 80% of them having some form of formal education. A majority of the patients, 66.6% were in NYHA class II and III. The prevalence of iron deficiency was 56.7%. Among patients with anaemia, the prevalence of ID was 86% and in non-anaemic patients, the prevalence was 43%. Functional iron deficiency was more common at 32.5%, compared to absolute iron deficiency which occurred in 24.4%. Conclusion: In patients with congestive cardiac failure, iron deficiency is common and is associated with a poor functional status irrespective of the presence of anaemia.